How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier None Typical Low $33.11 Median $48.98 Typical High $120.23 | Professional | None | $33.11 | $48.98 | $120.23 |
Anthem BCBS Setting Professional Modifier None Typical Low $29.51 Median $75.86 Typical High $190.55 | Professional | None | $29.51 | $75.86 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $144.54 Typical High $707.95 | Facility | None | $56.23 | $144.54 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $37.15 Median $102.33 Typical High $194.98 | Professional | None | $37.15 | $102.33 | $194.98 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $36.31 Median $85.11 Typical High $190.55 | Professional | None | $36.31 | $85.11 | $190.55 |
Martin's Point Setting Professional Modifier None Typical Low $33.11 Median $48.98 Typical High $120.23 | Professional | None | $33.11 | $48.98 | $120.23 |
United Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
United Setting Professional Modifier None Typical Low $42.66 Median $70.79 Typical High $190.55 | Professional | None | $42.66 | $70.79 | $190.55 |
10 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $18.20 Median $18.20 Typical High $60.26 | Professional | 52 · Reduced service | $18.20 | $18.20 | $60.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $7.41 Typical High $24.55 | Professional | 53 · Discontinued | $7.41 | $7.41 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $27.54 Median $27.54 Typical High $91.20 | Professional | 54 · Surgery only | $27.54 | $27.54 | $91.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $5.50 Typical High $18.20 | Professional | 55 · Aftercare only | $5.50 | $5.50 | $18.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $3.63 Typical High $12.02 | Professional | 56 · Pre-op care only | $3.63 | $3.63 | $12.02 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $18.20 Median $18.20 Typical High $60.26 | Professional | 52 · Reduced service | $18.20 | $18.20 | $60.26 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $7.41 Typical High $24.55 | Professional | 53 · Discontinued | $7.41 | $7.41 | $24.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $27.54 Median $27.54 Typical High $91.20 | Professional | 54 · Surgery only | $27.54 | $27.54 | $91.20 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $5.50 Typical High $18.20 | Professional | 55 · Aftercare only | $5.50 | $5.50 | $18.20 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $3.63 Typical High $12.02 | Professional | 56 · Pre-op care only | $3.63 | $3.63 | $12.02 |
Where Maine sits
The same service costs 5.4 times more in Wisconsin than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Maine· 43rd of 51
$89.13
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.